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Bruce Ettinger, MD; G. Thomas Ray, MBA; Alice R. Pressman, MS; Oscar Gluck, MD

Arch Intern Med. 2003;163:2741-2747.

Background  Whether limb fracture in elderly men predicts future fracture is unknown.

Methods  Electronic health records were examined to determine fracture incidence among men 60 years or older who were members of a large health maintenance organization, experienced no fracture in the past 2 years, and experienced an ankle, hip, humerus, or wrist fracture between July 1, 1997, and August 31, 2001. Proportional hazards models were used to compare risk of new fracture (ankle, hip, humerus, or wrist) between groups. Recurrent fractures of the same type were excluded from analysis.

Results  During the follow-up period (mean duration, 2.4 years), 0.5% of the control subjects without fractures experienced a subsequent ankle fracture; 0.6%, a hip fracture; 0.2%, a humerus fracture; and 0.4%, a wrist fracture. A limb fracture was about 4 times more likely to occur in persons who experienced a previous humerus fracture (relative risk, 3.9; 95% confidence interval, 2.5-6.0), about 3 times more likely to occur in persons who experienced a previous hip fracture (relative risk, 2.8; 95% confidence interval, 1.7-4.5), and about 2 times more likely to occur in persons who experienced a previous wrist fracture (relative risk, 2.2; 95% confidence interval, 1.4-3.5) than in controls. In contrast, persons who experienced a previous ankle fracture had no greater risk of subsequent fracture than nonfracture controls (relative risk, 1.0; 95% confidence interval, 0.5-1.9).

Conclusions  Among men 60 years or older, a recent hip, humerus, or wrist fracture is a statistically and clinically significant predictor of future limb fracture risk. An increased risk of future fracture is greatest after a humerus fracture and is lowest after a wrist fracture; however, among elderly men, a previous ankle fracture is not an indicator of future fracture risk.

From the Division of Research, Kaiser Permanente Medical Care Program, Oakland, Calif (Dr Ettinger, Mr Ray, and Ms Pressman); and the Arizona Rheumatology Center, Phoenix (Dr Gluck). The authors have no relevant financial interest in this article.

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